Vein Surgery | Doctors & Treatment Information

Veins are the blood vessels that carry blood from the legs and organs of the body back to the heart. Transporting blood upward from the legs is particularly difficult because it must work against gravity. This is why venous disorders most commonly occur in the legs and much less frequently in the arms.

The most common venous disorders include:

• Spider veins
• Varicose veins
• Venous thrombosis
• Phlebitis
• Ulcers

Below, you will learn about the characteristics of venous diseases and surgical treatment methods.

Venous diseases that require surgery

Varicose veins are dilated veins that develop when the venous valves no longer function properly @ gballgiggs /AdobeStock

Spider veins are common, and patients usually find them cosmetically unappealing. They are generally not a serious health concern. Spider veins are most commonly found in the back of the knee, on the lower leg, and around the ankles. These slightly dilated, small, superficial veins appear bluish or reddish through the skin. Spider veins develop due to venous congestion; in some cases, a genetic predisposition also plays a role.

Most patients with spider veins are women. However, it’s also possible that men suffer from them less frequently and therefore seek medical attention less often.

Spider veins are generally harmless and do not cause any symptoms @ zigres /AdobeStock

Medically speaking, a venous thrombosis is the blockage of a vein by a thrombus (blood clot). Most thrombi form in the deep veins of the legs and lead to sudden leg swelling. 

In rare cases, deep vein thrombosis in the leg can lead to a serious circulatory disorder in the leg. The opposite condition is the sudden blockage of an artery. 

Nevertheless, deep vein thrombosis in the leg can be dangerous. This is because the blood clot can break loose at any time and cause a blockage in a blood vessel (embolism) elsewhere in the body—for example, in the lungs (pulmonary embolism).

Venous thrombosis is often caused by long car or plane trips during which people are unable to move their legs properly. However, major surgical procedures can also be a cause, such as joint replacement surgery. 

Other contributing factors include:

• Vascular inflammation 
• Impaired blood clotting 
• Hormonal changes in women due to hormone therapy (menopause), taking the birth control pill, and pregnancy.

If a deep vein in the leg is affected, the calf may swell and become painful, tender to the touch, and feel hot @ Anna Bogatyreva /AdobeStock

Phlebitis is an inflammation of a superficial vein—and, rarely, a deeper vein. The blood vessel leading to the heart is thicker than healthy veins due to a blood clot. It can therefore be clearly felt. 

Phlebitis is always painful. You should therefore seek treatment promptly. The skin at the affected site is red and hot.

Causes of phlebitis include:

•  Clothing that is too tight
• Blood pooling in the legs and 
• Impaired blood clotting

Phlebitis is also problematic because it often leads to the formation of blood clots. Conversely, a thrombosis can cause phlebitis. The treatment of phlebitis depends on whether deep veins or veins just beneath the skin’s surface are affected.

Varicose veins (varices, varicosis) are pathologically altered, superficial leg veins that appear as bluish veins that are thickened in a knotty manner and protrude clearly beneath the skin.

The great and small saphenous veins (Vena saphena magna/parva) and their branching networks are affected. Varicose veins are often accompanied by severe pain, heavy legs, and a sensation of warmth in the lower extremities.

As the condition progresses, swelling (edema) develops. Because blood pools in the varicose veins, the patient’s legs are deprived of nutrients and oxygen. 

The removal of waste products from the tissue is also impaired. This leads to skin inflammation (eczema). The main cause of varicose veins is a genetically determined weakness of the connective tissue.

A venous leg ulcer (ulcus cruris) occurs when blood cannot drain properly due to thrombosis and/or varicose veins. It accumulates massively in the tissue. 

This results in significantly increased tissue pressure, preventing the inflow of oxygen- and nutrient-rich blood. It initially manifests as a thickened lower leg and reddish-brown discoloration of the skin. The hardened skin surface causes pain. 

The congestion, along with the lack of oxygen and nutrients, leads to the formation of wounds that no longer heal. This is called an ulcer. The wound caused by the ulcer is deep and usually heals poorly. If left untreated, an “open leg” can lead to life-threatening circulatory disorders.

Ulcus cruris (open leg) is a deep, slow-healing wound, usually on the lower leg @ kittyfly /AdobeStock

The most common vein surgeries are performed for varicose veins. Several options are available for this:

• Vein stripping

In the “classic surgery” (stripping), doctors expose the affected sections of the vein at both ends by making incisions in the skin. By inserting a metal probe, they pull out the section in between.

Vein stripping can also be performed using a cold probe (cryotherapy): The varicose vein freezes to the special probe and can then be easily removed.

If dilated connecting veins are present, ultrasound devices can visualize and mark them. The doctor then makes a small incision at the marked site and removes them.

• Vein Sclerotherapy

In sclerotherapy (vein sclerotherapy), the doctor injects a sclerosing agent—in liquid or foamed form—into the varicose veins. The doctor then compresses the varicose veins from the outside, causing the vessel walls to stick together and close off.

After the procedure, the patient must wear compression stockings for 2–4 weeks.

• Laser Therapy

In laser therapy, doctors insert a thin laser probe into the affected varicose vein. The laser energy generates heat within the vein, which irritates the vein walls and causes them to adhere to one another. The procedure is performed on an outpatient basis under local anesthesia. Compression therapy is also required following laser surgery.

• Radiofrequency Therapy

Radiofrequency therapy works in a similar way. Again, doctors insert a probe into the vein. The heat causes the vein walls to fuse together.

• The balloon catheter

In some cases, surgical treatment may also be appropriate for venous thrombosis. Several procedures are suitable for this, such as the balloon catheter. 

If a blood clot has lodged in the affected vessel, doctors insert a balloon catheter through the femoral vein. They then inflate the balloon and withdraw it, thereby removing the clot.

• Surgery for Leg Ulcers

In certain cases, a leg ulcer also requires surgery—specifically when the affected tissue on the leg is very hardened or extremely scarred. 

Under general anesthesia, doctors clean the ulcer and remove all damaged (necrotic) tissue. They then cover the wound with a suitable piece of the patient’s own skin (usually from the thigh).

Sometimes, sclerotherapy is also necessary at the site of the ulcer. This is performed using laser technology.

After the surgical procedure, it is important to treat any existing infection with special wound dressings and medications. Antibiotics are rarely necessary; in fact, they should be avoided. Otherwise, there is a high risk of developing antibiotic-resistant bacteria.